Is Early Surgical Intervention Effective for Traumatic Severe Cervical Spinal Cord Injury?

Abstract Background This study aimed to determine whether surgery within 24 h improves the neurological prognosis and reduces the complications associated with surgery for traumatic severe cervical spinal cord injury (CSCI). Methods The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were divided into early surgery (< 24 h) and late surgery (> 24 h) groups. Using inverse probability of treatment weighting (IPTW) with propensity score adjustment for confounding factors, the AIS grade before and 1 month following surgical treatment as the primary outcome were compared. The secondary outcome was the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest. Results In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The IPTW analysis indicated significant differences in neurological improvement according to the AIS grade at 1 month following surgery (odds ratio [OR]: 17.1 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), ICU-LOS > 7 days (OR: 0.14 95% Cl: 0.02–0.90, p = 0.04), respiratory complications (OR: 0.08 95% Cl: 0.01–0.73, p = 0.03), and cardiac arrest (OR: 0.13 95% Cl: 0.02–0.85, p = 0.03). Conclusions Early surgery (within 24 h) for traumatic severe CSCI may be effective in improving the neurological prognosis, and preventing a long ICU-LOS and postoperative complications.